Abstract
A 53-year old woman was referred to our hospital with fever and anuria. On admission, her serum creatinine was 7.7mg/dL and CRP was 28.2mg/dL. The electrocardiogram showed a QS pattern and ST segment elevation in the V1-V3 leads, and echocardiography demonstrated decreased wall motion in the left ventricle. Cardiac enzymes such as creatine kinase, myoglobin, and cardiac troponin I were elevated, suggesting the onset of acute myocardial infarction. However, coronary angiography did not show any pathological lesions, and left ventriculography demonstrated akinesis in the apical segment and hyperkinesis in the basal segment. Based on these findings, we diagnosed Takotsubo cardiomyopathy evoked by acute renal failure and sepsis.
Thereafter, we immediately started endotoxin-absorbing therapy using polymyxin B and continuous hemodiafiltration with antibiotics. Her general condition and laboratory data gradually improved, and left ventricular wall motion returned to normal. On the 7th hospital day, intermittent hemodialysis (HD) was initiated. On the 13th hospital day, renal function began to improve with an increase in urine volume. HD was successfully discontinued on the 25th hospital day.
We report here a rare case of acute renal failure complicated by Takotsubo cardiomyopathy. Severe stress such as acute renal failure and sepsis resulted in Takotsubo cardiomyopathy, leading to the acceleration of renal dysfunction. Takotsubo cardiomyopathy needs to be considered as a potential complication of acute renal failure.
